Does my child need a flu shot?

Each year, millions of children in the United States get sick with seasonal influenza (the flu), and thousands are hospitalized. While relatively rare, between 37 and 199 flu-related deaths in children have been recorded each flu season since the Centers for Disease Control and Prevention (CDC) began tracking the data in 2004. However, flu-related deaths are underreported and the CDC estimates that during the worst of these seasons, the actual number of deaths in children was closer to 600. According to the CDC, among pediatric deaths, about 80% of the children were not fully vaccinated.

Children younger than 5 years - especially those younger than 2 - are at serious risk of complications. This is why the American Academy of Pediatrics (AAP) and CDC recommend that every child 6 months of age and older who is eligible to get a flu vaccination do so at the start of flu season.

For the 2023-24 season, the flu vaccine is available in both injectable and nasal spray forms. The CDC has, in recent years, found the nasal spray, formulated with live virus cells, to be less effective than the shot. For now, health care providers are not making a specific recommendation about which formula of vaccination parents should choose. However, the nasal spray is contraindicated for some people. Children younger than age 2 should not get the nasal spray; they should get the shot. Others who should get the shot and not the spray include children ages 2-4 years old with asthma or a history of wheezing within the past 12 months, those who are taking certain medications, those with cochlear implants, and pregnant women. Caution is also recommended for children 5 and older who have asthma, as well as those with underlying medical conditions, including lung disease, heart disease, kidney or live conditions, and neurological, neuromuscular, and metabolic disorders.

It is unclear why the nasal spray, which is formulated with live virus cells, has been less effective in several recent flu seasons. For now, health care providers urge parents to have their children receive the nasal spray form of the vaccine if the shot is unavailable, so that they may receive at least some protection from the flu.

Who should get the flu shot?

Children 6 months of age and older should receive the flu shot, which is formulated with dead virus cells and generally has better than 60 percent effectiveness in preventing flu. Children who are between the ages of 6 months and 8 years, and are receiving the flu vaccine for the first time require two doses of vaccine. The first dose should be given as soon as it becomes available, to “prime” the immune system. The second dose should be administered 28 days or more later, to provide immune protection from the flu viruses identified as likely to be circulating during the current season. It generally takes about two weeks from the second dose for flu protection to be maximized. Children who receive the first dose without the second are at risk of getting the flu.

According to the American Lung Association (ALA), the flu vaccine is especially important for those who have a risk of developing flu-related complications or who are most likely to spread the virus to at-risk people, such as: 

  • children and adults with asthma, chronic obstructive pulmonary disease, heart disease, weakened immune system, diabetes, and other chronic medical conditions 
  • children 6–59 months of age 
  • children 6 months–18 years of age who are on long-term aspirin treatment 
  • pregnant people, during all trimesters 
  • caregivers of at-risk people, including parents of children under 6 months of age, who are too young to be vaccinated 
  • adults 50 years old and over 
  • residents of long-term care facilities 
  • health-care professionals who work with patients

How parents can reduce their child’s risk of flu 

The CDC offers a tip sheet on how to avoid the flu. First item on the list? Get a flu vaccination.

Some parents choose to skip the flu vaccine for their child, due to a concern about thimerosal, a mercury-containing preservative used in multi-dose vials of the vaccine that has been the subject of widespread media coverage linking it to autism. The CDC points out that research has not shown a causal link. Rates of autism continue to rise even though thimerosal has been removed from all vaccines except some multi-dose flu vaccines. It should be easier than ever to find thimerosal-free vaccines, in single-dose shots. Ask your health care provider about single-dose vials. But the CDC recommends that children get the shot even if a multi-dose vial is the only one available, emphasizing that the small amount of thimerosal in the flu vaccine is safe. 

Families should pay close attention to the second item on the list: good hygiene. Everyday preventative actions, like handwashing, using tissues to cover the mouth when coughing or sneezing, and avoiding touching the face are important strategies for reducing one’s flu risk—with or without vaccination. 

If your child does come down with the flu, speak with your health care provider as soon as possible. The AAP and CDC recommend use of certain antiviral medications for children who are at higher risk of serious complications from the flu, including:

  • children younger than 2 years old
  • children with severe symptoms
  • children who are hospitalized
  • children with underlying chronic health conditions, including asthma

The CDC also recommends antiviral medications for women who are pregnant or postpartum (within 2 weeks after delivery) and contract the flu. Use of antiviral medications should not be delayed, since the treatment works best when it is given early.

For more on flu, read this.

Last updated January 15, 2024

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